【摘要】：目的探討閉合性與開(kāi)放性脛骨高位楔形截骨術(shù)治療膝關(guān)節(jié)單間室骨性關(guān)節(jié)炎的療效。方法筆者自1998-03—2008-05采用閉合性脛骨高位楔形截骨(CWHTO)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎并內(nèi)翻畸形90例(95膝),與自2007-08—2012-07采用開(kāi)放性脛骨高位楔形截骨(OWHTO)治療的膝關(guān)節(jié)內(nèi)側(cè)間室骨性關(guān)節(jié)炎并膝內(nèi)翻27例(30膝)進(jìn)行比較。采用膝關(guān)節(jié)HSS評(píng)分、VAS評(píng)分對(duì)術(shù)后療效進(jìn)行評(píng)價(jià),下肢力線通過(guò)手術(shù)前后下肢全長(zhǎng)X線片脛股角(FTA)、下肢負(fù)重線比率(WBL)評(píng)估。結(jié)果 OWHTO組獲得平均60(36~96)個(gè)月隨訪。OWHTO組術(shù)后1周內(nèi)屈曲可達(dá)90°,術(shù)后膝關(guān)節(jié)活動(dòng)度、VAS評(píng)分、HHS評(píng)分、FTA及WBL均優(yōu)于術(shù)前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。CWHTO組獲得平均144(80~204)個(gè)月隨訪。CWHTO組患者長(zhǎng)腿管型石膏管型外固定4周后,去除石膏固定行免負(fù)重關(guān)節(jié)功能鍛煉2周,骨折愈合后逐漸負(fù)重行關(guān)節(jié)功能鍛煉。術(shù)后膝關(guān)節(jié)活動(dòng)度、VAS評(píng)分、HSS評(píng)分、FTA、WBL均優(yōu)于術(shù)前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。所有患者無(wú)感染、截骨不愈合或延遲愈合發(fā)生,無(wú)腓總神經(jīng)神經(jīng)損傷、股四頭肌力量及髕骨軌跡改變,無(wú)下肢短縮等發(fā)生,但行CWHTO截骨患者有下肢靜脈血栓形成、有平臺(tái)骨折發(fā)生。結(jié)論 2種截骨均能通過(guò)恢復(fù)下肢力線,達(dá)到緩解關(guān)節(jié)疼痛、改善關(guān)節(jié)功能,對(duì)于早期單間室骨性關(guān)節(jié)炎有較好療效,開(kāi)放楔形截骨更有優(yōu)勢(shì)。
[Abstract]:Objective To investigate the effect of closed and open high tibial wedge osteotomy in the treatment of unicompartment osteoarthritis of the knee joint.Methods From March 1998 to May 2008, 90 cases (95 knees) of knee osteoarthritis complicated with varus deformity were treated with closed high tibial wedge osteotomy (CWHTO) and 90 cases (95 knees) of open high tibial wedge osteotomy from August 2007 to July 2012. Twenty-seven patients (30 knees) with medial compartment osteoarthritis and varus knee were treated with osteotomy (OWHTO). The curative effect was evaluated by HSS score and VAS score. The lower extremity force line was evaluated by full-length X-ray of tibiofemoral angle (FTA) and lower extremity load line ratio (WBL) before and after operation. Follow-up. OWHTO group within one week after surgery flexion can reach 90 degrees, postoperative knee joint mobility, VAS score, HHS score, FTA and WBL were superior to preoperative, the difference was statistically significant (P 0.05). CWHTO group received an average of 144 (80-204) months of follow-up. CWHTO group with long leg cast external fixation 4 weeks later, removal of plaster fixation of weight-free joint exercise 2. All patients had no infection, no osteotomy union or delayed union, no common peroneal nerve injury, quadriceps femoris strength and patellar track changes, no lower limb shortening. Conclusion Both of the two osteotomies can relieve joint pain and improve joint function by restoring lower limb force line. They are effective for early unicompartment osteoarthritis, and open wedge osteotomy is more advantageous.
【作者單位】： 運(yùn)城市中心醫(yī)院關(guān)節(jié)外科;第四軍醫(yī)大學(xué)第二附屬醫(yī)院(唐都醫(yī)院)骨科;
【分類號(hào)】：R687.4

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